Utilization Review RN II — Care Coordination Expert

Marin General Hospital dba MarinHealth Medical Center; United States; On-site; USD 137,000 - 206,000; Full time

Job summary

MarinHealth Medical Center in Greenbrae, CA, is seeking an experienced Utilization Review Nurse to perform admission, concurrent and retrospective reviews for designated health plans. This role requires a California RN license and a BSN preferred, with strong knowledge of utilization management and evidence-based criteria.

You will work with the Medical Director on denials and appeals, coordinate transfers, and ensure quality patient care while maintaining high accuracy in documentation and use

Qualifications

• Bachelor of Science in Nursing preferred.
• Three or more years in acute care, preferably medical/surgical or critical care.
• California RN license required at hire; BLS required at hire.

Responsibilities

• Complete admission, concurrent and retrospective reviews for designated health plans.
• Assess clinical stability and coordinate transfer back to Marin General for continued care.
• Appeal medical necessity denials and review denials with PMG/Payer if needed.
• Maintain documentation and coordinate with Medical Director on complex cases.

Skills

RN license

BLS

Utilization review

Discharge planning

Education

Bachelor of Science in Nursing

Job description

MarinHealth Medical Center in Greenbrae, CA, is seeking an experienced Utilization Review Nurse to perform admission, concurrent and retrospective reviews for designated health plans. This role requires a California RN license and a BSN preferred, with strong knowledge of utilization management and evidence-based criteria.

You will work with the Medical Director on denials and appeals, coordinate transfers, and ensure quality patient care while maintaining high accuracy in documentation and use